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Survival After Relapse of Medulloblastoma

Koschmann, Carl MD; Bloom, Karina BSc; Upadhyaya, Santhosh MBBS; Geyer, J. Russell MD; Leary, Sarah E.S. MD, MS

Journal of Pediatric Hematology/Oncology: May 2016 - Volume 38 - Issue 4 - p 269–273
doi: 10.1097/MPH.0000000000000547
Original Articles

Survival after recurrence of medulloblastoma has not been reported in an unselected cohort of patients in the contemporary era. We reviewed 55 patients diagnosed with medulloblastoma between 2000 and 2010, and treated at Seattle Children’s Hospital to evaluate patterns of relapse treatment and survival. Fourteen of 47 patients (30%) over the age of 3 experienced recurrent or progressive medulloblastoma after standard therapy. The median time from diagnosis to recurrence was 18.0 months (range, 3.6 to 62.6 mo), and site of recurrence was metastatic in 86%. The median survival after relapse was 10.3 months (range, 1.3 to 80.5 mo); 3-year survival after relapse was 18%. There were trend associations between longer survival and having received additional chemotherapy (median survival 12.8 vs. 1.3 mo, P=0.16) and radiation therapy (15.4 vs. 5.9 mo, P=0.20). Isolated local relapse was significantly associated with shorter survival (1.3 vs. 12.8 mo, P=0.009). Recurrence of medulloblastoma is more likely to be metastatic than reported in previous eras. Within the limits of our small sample, our data suggest a potential survival benefit from retreatment with cytotoxic chemotherapy and radiation even in heavily pretreated patients. This report serves as a baseline against which to evaluate novel therapy combinations.

*Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Michigan School of Medicine, Ann Arbor, MI

Division of Pediatric Hematology-Oncology, Seattle Children’s Hospital

Fred Hutchinson Cancer Research Center

Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Washington, Seattle, WA

§Department of Oncology, Division of Neuro-Oncology, St Jude Children’s Research Hospital, Memphis, TN

Supported by Seattle Children’s Research Institute Mentored Scholars Program to S.E.S.L., and St Baldrick’s Foundation Fellowship, the Alex’s Lemonade Stand Foundation/Northwestern Mutual Young Investigator Grant to C.K.

The authors declare no conflict of interest.

Reprints: Carl Koschmann, MD, Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109 (e-mail: ckoschma@med.umich.edu).

Received July 30, 2015

Accepted January 23, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.